Long-term care for the elderly faces challenges

New trends in long- and short-term care for the elderly pose a variety of problems for care providers. Tighter government regulations and deep cuts in funding are forcing long-term care facilities to find new ways to fund and provide services for the elderly or give up some of those services.

When people age, they face some of their biggest health challenges as well as the death of friends and spouses. This is the time when they are least able to cope with or even understand the changes in the health-care and insurance industry. But some of these changes will affect the care that they receive and the way that care is managed.

With all the abuses in the Medicare and Medicaid system, it is clear that the government wants to get out of the health-care business. New legislation has allowed Medicare recipients to sell their benefits to a health maintenance organization. An HMO will manage their benefits, offering some of the same services while trying to make a profit.

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“The problem I see is that many older people don’t know what they are signing up for,´ said Sheryl Nelson, administrator at Applewood Living Center in Longmont. “They don’t always understand what their benefits are, and often the families don’t know that their parent has signed these benefits over to an HMO.”

In addition to managed care’s involvement in federally sponsored health care, it is apparent to all long-term care providers for the elderly that funding is slowly drying up.

“We are going to have a lot more elderly people who need care in the next few years, and the cost of care is going up,” Nelson said. “It is really going to be a challenge for those of us in the long-term care industry.”

Applewood Living Center is a skilled nursing facility that has 120 resident beds and charges from $109 to $114 per day for semiprivate rooms. Applewood does not have an assisted-living facility.

Nelson said that one of the new trends at skilled-care facilities is the growth in acute-care or rehabilitation units. Hospitals are moving people out more rapidly, and many of these patients need intensive rehabilitation and therapy. Long-term care facilities are filling the gap for those who are alone or have no one to care for them at home. Although most of these patients are elderly, some are not.

“About 35 percent of our residents go home after they receive care here for broken hips or other problems,” Nelson said. “Staying in a facility like ours is about half the cost of staying in a hospital.”

Dan Wellman, administrator at Spring Creek Health Care Center in Fort Collins, sees a significant change in the types of services that are now offered in skilled-care facilities and the acuity level of the residents.

“People are coming in here at a more acute level; they are more debilitated,” he said. “They stay at home as long as they can. Whereas years ago we had people that were less dependent, and nursing homes were more like assisted living or foster homes today.

“I feel that fewer people are being taken care of in their homes now, but I don’t have any evidence of that,” he added.

Spring Creek has 58 assisted-living units, 120 skilled-care beds and 20 to 28 people in post acute care or rehabilitation. Assisted-living units are about $1,300 per month with three meals, skilled care is about $114 per day, per person. Wellman said that assisted living is the fastest-growing area of long-term care.

“It has had the fastest rate of growth because it is unregulated,” he said. “Acute care is the most costly because of all the therapy that is required and the skilled staff. There is a lot of growth in long-term care because people are living longer.”

Medicare is now limiting the amount of money it will pay to $1,500 per person per year for therapy. Wellman says that this means that some people won’t get the therapy they need or that nurses rather than skilled therapists will administer the therapy.

Administrators everywhere are struggling to come up with creative ideas for long-term care patients, and few have any solutions as they watch the regulations change constantly.

“Each and every day we hear new information on funding and regulations,’´ said Art Hess, administrator at Bonell Good Samaritan Center in Greeley. “It is a challenging time, and I don’t know the answers. We have lots of people who need care, and we hope that common sense will prevail. By the year 2030, the 85 plus age group will double, and that is scary when we ask, ‘Who will care for us?’

Hess said that children of aging parents are now better-educated and do a lot of research on the care facility before they admit their parents.

“Kids want a place where they don’t have to worry about their parents if they fall or get sick,” Hess said.

Good Samaritan Center is a large facility with a campus of housing that includes 150 apartments for seniors, 41 assisted-living units and 264 beds in the health-care facility. The assisted-living units run around $55 per day and include various services. The skilled-nursing facility costs from $100 to $120 per day and also comes with various services.

“We have over 400 staff members, and we have a Christian orientation,” Hess said.

Another major change in long-term care is the prospective payment services plan that the government is implementing in the Medicare system. Each long-term-care facility will be paid a set amount per resident patient based on the costs they have reported.

“They have changed the law so that now every care facility and hospital will be under the PPS plan, which means that they will no longer pay for each service separately,´ said Applewood’s Nelson.

Changes in the Medicare regulations usually create more paperwork for care facilities, and the cuts in funding worry some long-term care administrators who wonder if they can provide the level of care their patients need.

Some facilities have tried to prepare for the cuts. Stacy Stolen, director of admissions and marketing at North Shore Health Care Facility in Loveland, says that they are ready, and she does not expect the level of their care to change.

“We have been preparing for these cuts for a long time,” she said. “We are always very cost-effective, so we don’t expect our care to diminish. We are committed to offering all the care possible, and we think that we are prepared.”

North Shore has 121 beds in its health-care facility. An assisted-living center, as well as a 30-unit Medicare rehabilitation unit and a 12 bed Alzheimer’s unit, are also under construction. Admission costs range from $103 per day for semiprivate to $125 per day for private rooms.

Stolen said that the number of Alzheimer’s patients is growing rapidly because people are living longer, and it is harder for families to care for these people in their homes.

The rates for long-term-care patients are also going up every year. “I think that rates have gone up from 5 to 7 percent a year, and a lot of that is driven by what Medicare pays us,” Stolen said.

Adam Merrell, administrator at Cheyenne Health Care Center in Cheyenne, says that the long-term-care industry is growing because “the care is much better than it was years ago.”

“People know what to look for, and they are more comfortable placing family members in long-term-care facilities,” Merrell said. “Families can’t take care of people in their homes, and there are more services available to them.”

The Cheyenne care center has 94 residents, and room costs are $111.30 per day for a semiprivate room and $115.50 per day for a private room.

Merrell thinks that some of the lobby groups representing senior citizens such as AARP might be able to prompt the government to enact some positive changes with regard to long-term care, as the population ages.